Publication date: Jun 23, 2025

Public health units (PHU) require adequate funding to service the needs of their community. This study examined the association between PHU funding and adolescent mental health trajectories from 2018 to 19 to 2020-21 in Ontario, Canada. Longitudinal adolescent data from the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) study (n = 6043) was used. Adolescents reported on depression and anxiety symptoms via questionnaire. Data on funding from 12 PHUs was obtained from the Ontario Public Health Information Database. We used multilevel growth curve analyses to estimate whether PHU funding modified trajectories of depressive and anxiety symptoms while adjusting for student, school, and area-level covariates. We also tested for heterogeneity by gender and performed gender stratified analyses. PHU funding modified depression trajectories. Differences in depression scores by level of PHU funding were not significant at each time point. However, students attending schools in areas with lower PHU funding had smaller rates of growth in depression from 2018 to 19 to 2019-20 (Low PHU: ∂ = 0. 50, 95 % CI: 0. 27, 0. 74; High PHU: ∂ = 1. 10, 95 % CI: 0. 81, 1. 39), but larger rates of growth from 2019 to 20 to 2020-21 (Low PHU: ∂ = 1. 66, 95 % CI: 1. 32, 2. 00; High PHU: ∂ = 0. 70, 95 % CI: 0. 35, 1. 05). Findings were similar in female stratified models. PHU funding did not modify anxiety trajectories. Trajectories of adolescent depression symptoms, particularly females, during the COVID-19 pandemic may have been modified by the level of PHU funding. More research over a longer period and in different jurisdictions is needed.

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